Latest developments in Surgical Robotics From SRS 2024 (Society of Surgical Robotics)
- Steve Bell
- Jun 25, 2024
- 26 min read
Updated: Jul 30
Robotic Updates
Sorry disclaimer first - there were tons of amazing “non surgical” robots at SRS and I will cover them in details - but this is to cover the ever expanding surgical robotics space.
If you’re in this space you can learn about the systems that were at SRS from my perspective by interacting with them all and discussing from the floor — “So what do you think?” With attendees.
Some very interesting insights - a bit long but as usual some very provocative statements.
Remember buying access to the blog will get you access to all the exclusive articles and deep dives into surgical robots > https://www.howtostartupinmedtech.com/blog/categories/exclusive-content
Da Vinci 5
I finally got to meet the da Vinci 5 face to face and got a great test drive.
It’s everything I thought it would be from Intuitive - and the quality and build is just top notch.
I won’t opine again about all the great things about it - it is just the leader and set to be the leader.
But let me tell you a few things that I think were areas that are not as strong as the marketing may suggest (today as I think a lot of this is software).
Vision system: You have to take this from someone that has done most of my robotic development and case work on an open console - so going back into the periscope is always hard for me. But even in DV5 I think the periscope view compared to the Xi is better - the screen is brighter, the resolution is better, the black point is better, the luminosity etc.
But all periscope views just feel - well “small” compared to open console screens. Small and “artificial.” It’s hard for me to explain - but you know you are inside.
I know I’m an open console fan - but this test drive (and all the periscope views at the exhibition) just reaffirmed to me that for half of us, the open screen on an open console just feels better. 100% subjective. But I didn’t see enough companies offering both options…
Menu system: On the other hand the immersive menu system - and basically bringing the smart OR into the console - with images - menus etc is brilliant. The UX is modern - well designed and could be an “Apple” device. I personally liked the cursor mode and the way you interact with the menu using the hand controllers. But I got lots of feedback from surgeons saying they didn’t like it. Some said it was way too sensitive and annoying.
Maybe I’m just used to screen menu interaction as a gamer?
So what was that “one thing” I saw that makes me understand that they have full instrument tracking (visual) and identification of scenes etc. It was the way the cursor jumped to the instrument identifier and moved with it - labelled it. The system was knowing (maybe a mix of visual and kinematic data) which instrument and where it was.
I can already envision what software will gradually be turned on here as they get regulatory clearances. They know what instrument it is - where it is in the scene.
Force Feedback: Again having been involved in various Force Feedback evaluations and different versions of haptics - I enjoyed the force feedback. It is way lower “forces” to the haptic arms than is a direct 1:1 translation - even with the high settings. So for me it feels like “representative” or “Approximate” force feedback not direct 1:1 translation.
I’m fine with it as I’m used to to zero force feedback and my visual haptics adapts to this force feedback and adds to it. But I had feedback from several that “tried it” in the box, but also surgeons actually clinically using it, that they’ve turned it off. Some are feeling it is not “real enough” and that the XYZ force sensing is not as valuable as palpation would be.
So it was a mixed bag.
I think for many starting on a DV journey it will be a great aid in getting them from lap to the robot.
But it is clear that this is not “finished” yet - and now I understand some of Intuitive’s caution around this and “let’s see how it goes.” “Let’s see the feedback.” That’s smart for them to cover their bases.
All in all I think it’s good and if I was a surgeon I would persevere with it and keep it turned on.
Insufflation: I finally got to see what the small black window was next to the insufflation socket - it is yet another touch screen. There are touch screens all over and they are gorgeous by the way. In fact the entire way that the UX is represented across all of the touch screen interfaces, tower, helm, console is all thought out and intelligent in the adaptation for the interface… yet allowing consistent functionality.
So the question I had is “Is this better than AirSeal the market leader?”
So a very very mixed bag of answers.
Some said it’s good. But half the surgeons I talked to said it was not responsive and powerful enough. It felt laggy compared to an AirSeal. But there’s said that the issue with Airseal is that it drags in ambient air and a lot of people didn’t like it - so are willing to suffer the lag for the trade off against ambient air.
However quite a few said - they would prefer the Lexion insufflator - and a few said they would use that as opposed to the built in. Da Vinci system.
But there was internal debate in their heads (I could see it) if that then means that it’s a waste of the tower and integrated features.
I would say that I think Intuitive must tweak the flow settings if possible to find a profile closer to Lexion if they want satisfaction across the board.
Okay DV5 is the new king and will be the king - even with my observations on it. It is way smoother and feels more precise than any other system I tried there (or have tried historically).
And floor conversations already indicated to me that hospitals and surgeons are saying (as I predicted) that they now see no need to get new towers for many ORs where a DV is installed. And (as predicted) they feel they get a smart OR in a console. There was no one (and I talked to a few big system administrators that attended) that would upgrade to a smart OR until they fully understand if this could replace it. And yes they understood the ability bro save on the OR cost and tower cost and offset it against a DV5. That math is happening.
I suggest Stryker gets it’s ass in gear - I predict (even more so after conversations) there’s a 24 month window until you see a dip in smart Ors and even in towers. That race is now on. And especially as I saw that all of the Chinese robots are bringing their own towers with their own vision systems - insufflators - energy and advanced energy.
Storz have been smart - now they need to digest and move and MUST get LUNA out.
Olympus - you need to move
Stryker (especially for the US) - I don’t think you have time to wait… unless you don’t really care so much about your tower business. This for me is not the moment to wait and see.
All in all DV5 gets a 9/10 from me. (Not that they care - hahahaha)
Chinese robots (Asian)
I’m going to double down that they will struggle to gain meaningful traction in the USA and Europe - just because of the stigma attached to “Chinese.” But as Vip Patel said in his talk - they are way more capable, better quality and in some ways pushing the boundaries more that some of the western robots.
One thing is for surge - their development is way faster and way cheaper. The advances they have made at breakneck speed are incredible.
Microport - Medbot - people need to take this company seriously (as a company). They have six robots across the categories - with surgical robots in multiport and single port coming. They have Ortho robots with Skywalker - hair restoration - diagnostic US robots and endolumenal.
Remember the Medbot division is just a spin out of a way way way bigger and very successful multinational in other therapeutic areas.
So TOUMAI - their Xi clone. A few observations - firstly the quality was pretty impressive - and it is quiet - very quiet - and way smoother than I imagined. Now this is the thing in their favour (and I heard it from multiple people that have vast experience in Xi.)
They all said the same thing - that after a few minutes you can forget you are not driving and Xi. And that should make Intuitive worry in some respects (but not others).
It’s an easy translation (And this has not been lost on FDA - more later.) so easy for people to take this as a “cheaper” alternative.
It misses a lot of the high end features - staplers - articulated advanced energy - ICG —- For now. They are all coming - I guarantee it.
They will (and are) having success in areas that Intuitive have traditionally paid less attention to and where DV5 will launch last - Africa, Eastern Europe - where installs are already happening. And I can predict some rapid deal flow here. Will it work - YES 3000+ procedures have shown that. So it will gain traction in peripheral markets - at lower value. So one to watch.
(I’d love to grab their marketing department though… this kind of marketing may work in China - it is not going to work in the west… more in other posts.)
Sagebot - Kangduo - Not quite an Xi clone - some nice features like already has advanced ultrasonic energy - nice imaging. Horrible marketing - I mean really horrible.
But the one thing that jumped out and hits a trend later in this post is it has pretty cool telesurgery capabilities:
Dual drivers: There are 5 arms to this robot. One scope and four instruments can be engaged simultaneously. And the pretty wow factor is twin or dual driver capability. Two operators can control two arms each at the same time - it’s not a “hand off.” So you can do genuine assisted surgery.
Now cool yes- but without coordination I could see some crossing of swords here. Plus you only have one camera view so working space is dictated by operative view from just one camera.
Now even more wow - was that you can link at least three consoles and have a “Robot party” and have an observer or expert drop in for the exciting bits - observe - help - assist. And all three of these can be in different global locations. Yep - bonkers as it sounds - 3 operators sitting in 3 countries operating on a patient in a fourth country. (Get your noggin around that.)
Real world use… let’s see. Cool factor - well.. why not.
Ronovo Robotics- Carina: By far the best robot from the Chinese stables. Why? It’s unique and Original. I have done a deep dive into this on my podcast and YouTube channel. So grab a listen here > https://youtu.be/tlJN2QWe7SI?si=YOzCpqKr2ApFO0oW
This is China’s first modular robot and it is small stable and compact. It feels very much like using a da Vinci Xi - even though it is modular.
They have worked hard on 8mm wristed instruments and 5mm straight instruments. They have their own vision system with ICG but not can use others vision systems to reduce cost.
It was very nice to see their ultrasonic scalpel already there - so it feels quite complete.
Set up is familiar to Xi users for port attachment.
Well built and extremely high quality. John Ma and team have knocked it out of the park and it was a pleasure to drive.
I'm going to say it again. This should be Hugo 2.
Shurui - Single port: Okay so some days R&D madness just takes over. I’m not wanting to pick on this robot - but it is just nonsense personified. It is using multiple arms to come together to do what an SP does with one arm. It’s just mad. I can only describe it as over engineered and almost silly. I cannot tell you how many surgeons were literally scratching their heads when looking at it. Sorry to be brutal but some things just don’t need to exist.
SSI - Mantra 3: I’ve covered their launch extensively in a blog recently. I had a chance to take control of it in a test drive. It’s an interesting concept and their focus on cardiac did not go unnoticed by a lot of surgeons - Cardiac will have a new resurgence in robotics.
Their arms are better than Mantra 2 - slimmer and smoother. - Their chair “consoleless console” is interesting and you have to drive it to feel it. I personally like what they are trying to do with the free floating - “non tethered” controllers - they are pushing the boundaries (But see MMI later). For me the implementation is not quite there. And a lot of feedback from the floor was that it takes some getting used to and doesn’t feel as accurate as say a da Vinci control system. I personally struggled a bit because I’m so used to haptic arms. I would caution them that the controllers and headset are “great innovations” but the implementation may need some work.
The 1/3 price tag was touted by a lot of people as game changing. But again to caution the team (and I know this may not be the final production version) but when you get close and personal - as someone that this really really really matters - the final fit and finish needs work. There are exposed wires and connectors that are visible to users. You cannot have that kind of finish - even on a lower cost system. It will be absolutely fine in India - I’ve worked there for 20 years. But that system at that build quality today will not be accepted in USA or Europe. Biomedical engineering will push back. So Sudhir and the team should really ensure that fit and finish get to standard.
All said - a really great example of pushing the envelope and bringing genuine alternatives.
Plus I love the team - genuinely motivated people that are building with a passion and purpose.
European robots
RobSurgical Bitrack: Out of the Spanish stables comes RobSurgical and Bitrack (a name that does’t translate that well - sorry guys.)
But some really nice technical engineering. If you talk fit and finish… the bedside unit is amazingly well designed from a fit and finish point of view. Look closely - they have built it with ZERO visible screws, bolts or screw heads. It is quite impressive from a geeky engineering point of view and does give the bedside unit a very polished feel.
Four arms hang from a very big central boom - and even though the footprint feels - small ish and bed side access feels good - the mass of metalwork to make this all happen is just industrial. They don’t use Z rails - and the terminal joints are in the style of sort of a bigger Senhance sort of joint. So no docking - finds it’s own pivot point - uses standard trocars (non docking)
What I liked about it is the way you interact with the arms - with a light touch in a certain area that is “touch sensitive”.
The console is “okay” but feels a little research project like. Interestingly like DistalMotion you can use it sterile or non sterile. That is nice.
It’s early for them - and even though they are convinced it’s mobile. It falls into the mobility style of a C-arm. Yes you can move it when it’s all folded down - but… will you move it.
In summary Todd Usen and the team have a bit to do on positioning, refinement (try and get the bulk down) but this is an alternative way to do mixed laps and robotic surgery but with four arms.
Marketing will get a bump with Todd as Chairman (I imagine) - so this is one to watch - and big credit to the team that have done this on a fairly modest budget.
Asensus - Senhance and Luna: There in name but not in robot. Gets a mention because of the recent acquisition activity by Storz. (Smart move… smart move…)
This is one to watch and Antonio talked about the system - and I do give big props to Antonio for seeing the ISU (Intelligent Surgery Unit) as a pathfinder technology for what is coming behind.
Luna will take a massive effort to finish - get out and launch.
Why European??
So Senhnace started as ALF-X in Europe - went on a vacation to the USA - and is now coming back home as Asensus - Storz.
CMR Surgical - Versius: the robot was absent but CMO Mark Slack was present to represent and covered some recent advances. The word from the floor was that recently the release of a Cadier grasper was a big improvement - and some recent software updates (benefits of strong software designed system) has helped. The recent launch of V-Limelite (white light ICG) has been welcomed.
The opposing word from the floor was that the instruments are still not there - CMR started and had a lead and did not keep momentum and are now being passed by many of the new entrants.
But as acknowledged by Mark. They are still the number 2 robot on the planet in terms of installs and the 23,000 procedures performed to date.
My quick calculation though shows that the ramp rate of other companies like Ssi and Microport - they will get surpassed in 12 months in Installs and procedures unless they ramp back up to the install rate once seen.
One thing I will say to any strategic reading this. If you buy them now - and you incorporate them into your program - in 24 hours you are defacto the number 2 robot in soft tissue surgical robotics. And could retain that place - having two systems on the market to stratify your offering.
DistalMotion & Moon surgical : European through and through but I’m covering under Advanced Assisted Laparoscopy.
Strategics
Stryker: Out of all the strategics that presented fire side chats Kevin Lobo’s talk was the most excellent (Bill and Ted) and real. Kevin knows his shit in the space of Mako because he has lived a launch. He knows how hard it is - how much cash it burned and how hard it is to build momentum - even if you are Stryker.
He admitted he knows they need to take a look at general synergy but that he is not stupid enough to go directly head to head with Intuitive. That is humility right there - self awareness.
If I walk out of SRS with one thought - it is that Stryker needs their 1788 visualisation system as the hero - and that means DistalMotion or Moon surgical are the right buy for them. It puts 1788 at the heart of the system - but also allows their Smart OR (maybe in a new form) to have a “robot” at the heart of it. Strategically it’s the right thing to not go head to head to head with Intuitive and allow them to go where Joe Mullings says (to fight a kick boxer fight them in a phone booth). That phone booth is the ASC and Stryker own that space. It’s all a match made in heaven.
Now it is just down to - do they want a more lap approach or a more robotic capable approach. Hell - Kevin - take both and own the whole god damned category !!!
Medtronic: So no robot on the floor and some saying they had is secreted away in a room as they are in late FDA discussions so don’t want to jeopardise current discussions. However there were a ton of other robots on the floor that are thundering through FDA. So It’s the corporate issue maybe surfacing?
But telling is the fact they had a laparoscopy booth of modest dimensions - at an international congress all about robotics and HUGO was just invisible in so many ways. It screams to me they have this all backwards and are not understanding much about how this all works. Or they are slowly getting more embarrassed about Hugo?
The word from the floor was actually quite damning. Surgeons did not have great feedback. And these are some of the their current top users. Too big - instruments issues - major software issues - but a nice console. The praise was on Touch Surgery and advances there (this is a theme that the software for them is the hero not the robot.)
It’s all just backwards. I am vocal that HUGO is the wrong basic format - it’s too big - too bulky and just an excuse to hang stapler’s and advanced energy on it. It’s backwards.
Fred Moll said it eloquently - Da Vinci was designed to be an amazing suturing machine - and everything stems from that. Advanced energy and stapling were wristed adjuncts - knowing how critical wristing was.
It was clear they are struggling to get their premium products on HUGO - Ligature and Signia Staplers - and it was promised they are pushing hard to get them to the market. Maybe at that point HUGO will start to make some sense.
Summary from the floor - “Hugo is not the answer.”
JNJ Ottava - Velys - Polyphonic: So JnJ had a booth and actually had two robots on it. Velys orthopaedic navigation system and Monarch their robotic bronchoscopy (more later).Velys and the recent expanded approvals is encouraging - and JNJ is learning what it means to “get a robot out”. But this is a low complexity robot, and highly linked to implants. It’s great looking and they are getting a lot of cases done - they are big and mighty as a company.
Let’s talk about the Elephant as the table. Sorry on the table.
I know Hani and Rocco from JNJ. And both were up on the stage to talk. I felt for both of them. I mean really felt for both of them. Both were constrained to say over and over again “Ottava is coming - it’s great and I wish I could tell you more.”
The disappointment in the room was palpable. There is a point where keeping your cards to your chest becomes a diminishing return. There is a point when it becomes damaging to your brand. The distinct sentiment was that this approach is now damaging brand. I could feel it across everyone in the room - industry pundits - investors - surgeons - admins.
It’s hard to know if they are better just being totally absent from the stage at this point. I know it’s close - they mentioned IDE multiple times. And they are bullish they are on target.
They had a teaser of the bed. They had teaser images of the console and console scope view. But this is not working for them. At SRS I got the distinct feeling they were now annoying people.
And this is what then happens… They launched what is potentially a good looking system and a good looking idea - their software hub of Polyphonic. I was expecting a big noisy launch and fanfare (you see what I did there… polyphonic… fanfare…. forget it). But it was almost a throttled dribble out.
Partly it was not launched as launched should be. But I also feel that it was a damp squibb because of the lack of Ottava news. It’s a bit like everyone is expecting a new amazing car to launch (or at least get a quick peak) - and they showed the infotainment system. At some point in any product category cycle it becomes “Too late.” And my fear is - it’s too late. Showing the infotainment system is not enough to keep people hanging on.
Now to be fair - Polyphonic is not just the robotic based system - it covers a lot more than that - including Ortho and other specialties. And can be used for a broad range off surgery and it is a lot more than just a Robotic Companion app. So it is a good base - and of course it will ship with Ottava. But coming to SRS and showing the Polyphonic as the “launch” certainly did have a lot of people scratching their heads.
Again the whole approach just felt like an add on - even though Tim Schmidt gave a nice fireside chat - and he was an excellent presenter. But he couldn’t say much - but he defiantly did have a sense of urgency around this. So hoping to see IDE “approved” notice Q3 / Q4 for Ottava. And if Q3 then we could se a first in Human in Q4.
Summary from the floor: Frustrating everyone
Single Port and Mini Robots
As we now get deeper segmentation of the robotics market - there is an emerging class of single port and a sub class of Mini Robots emerging. Basically single point of entry - and then flexible arms and an imaging system through the same port:
Da Vinci SP is the daddy of them all - and is slowly rolling out. But even this is slower than maybe some expect (unless you lived through SILS - Single Incision Lap Surgery). In which case you know it’s a force fit to try and do things in a more difficult way through a single incision rather than just suck it up and make lots of port in the patient.
Important in Korea and Asia (maybe Brazil) where scars are not accepted - so less is more.
It was there - there were sessions - there is a growing support - but it will find its own level in lap surgery. With SP +1 port, SP +2 ports — oh hang on - that’s multiport……….
But in transoral and transanal I think it has huge merit. And this is the frontier for this.
Virtual Incision - MIRA: So that translates to MIRA as well - single incision - becomes multi port becomes “Why?”
So MIRA has a few neat tricks up it’s sleeve. Firstly unlike SP it does not have a big bedside tower. You literally get it in a box - ready to go with zero bedside footprint - and unlike Ottava - I mean ZERO bedside. Now it still has a console and a mini tower - so no zero OR footprint.
I got to drive it - and the kinematics are somewhere between lap and robotic. The little arms (2 of them) don’t have wrists - so it’s sort of a flexible. Makes suturing more challenging but it’s probably teachable. Instruments were nice - accurate scissors - good cutting. Movement fluid with a massive range of motion to operate in an almost 180’ arc.
My question going in was - is this strong enough to so any real surgery? And the answer is YES. They did a neat demo where I held the arms in my hands and tried to forcibly stop them moving. You can’t - it’s way stronger than you think.
Still same questions - what procedures will it fly in. But with no bedside footprint - MIRA in a box - means most ORs are robot ready - and I see smaller ORs with fast turnover getting a benefit in the right procedures.
I think when they find their “space” (you see what I did there as again… space MIRA…) - they will be an interesting alternative. And If I was a strategic - this again might be a really nice tuck in to give me robotic breadth to find ways to combat Intuitive. Plus for some… maybe get something FDA cleared tomorrow. Get you in commercial action.
Vicarious Surgical : So to round us out I got to meet up with CEO Adam Sachs. They didn’t have the robot there as it is still early for them. But we had a good general chat. It is another single port variant but this time like SP, with a bedside console - but is hyper flexible with the big USP of operating back on yourself - on the roof etc.
In fact they are setting up for reasonable size ventrals - which is where it could be a good and meaningful start. But lots of work to do. But good to hear progress from Adam, and one to watch.
Advanced Assisted laparoscopy
Moving now to this big and exciting category. Some may call it Lap 2:0 - some like me call it Advanced Assisted Laparoscopy. It’s basically bringing robotics and robotic style data driven devices to a section of laparoscopy - with the aim of digitising it - but in a more meaningful way by also working to eliminate OR FTE needs and bring meaningful savings in human resources and money to operating rooms.
At the same time bringing some of the elements of large mainframes and data. Such as stable scope - 3rd arm (for the surgeon) stability - retraction - data etc.
And most importantly keeping the surgeon scrubbed at the bedside - which for simple procedures or using staplers or energy from a 3rd party is a must.
Moon - Maestro - I’ve covered in details - it’s a two arm lap assistant but so much more than a scope and instrument holder. Feel it to believe it.
They were there in the “Moon truck” a mobile experience to get you hands on Maestro. The truck is small… because it can be - end of story. No console - no dedicated tower - small form factor - small compact arms - it packs a punch.
If Stryker or Olympus or one of the other instrument / tower companies don’t make a play for this soon - they are insane. It has EU clearance - FDA Clearance - and makes the tower the hero - yet brings new insights on data powered by Nvidia. What’s not to love about this as a tower company.
Could it also be a tuck in and segmentation for a JNJ or Medtronic - hell yes. Opens up the ASCs and does not go directly against Intuitive as it’s not a robot in the purest form of tele manipulated soft tissue robotics.
It was great to interact with CEO Anne (one of the few female CEOs- come on ladies we need a bit more emotional intelligence and different opinion around us at this level) on the panel - and she gave clear reasons why moon exists.
DistalMotion - Dexter - Step one level up in laparoscopy and you bump into Dexter - a capable two arm robot with fully wristed instruments - when you want them - and it tucks out of the way to allow you lap access when you don’t. Sterile console keeps you bedside.
Don’t be fooled - fully functional robot but it’s sweet spot is in the lower acuity where lap manoeuvres are ideal to get you to the complex part of surgery - say anastomosis - or suturing a mesh in. At that point you dock in and go robotic. It’s based on the concept of Intuitive - make it easy to suture endoscopically. But unlike Intuitive - go lap when it counts.
Again it keeps the tower front and centre. Bang a 1788 by Stryker on this and you have a formidable weapon in the ASC.
Great to see CEO Greg Roche in the flesh - and hear his reasons for Dexter. Then some live surgeries beamed in and well Distal was a strong show at SRS. I think it may have got the attention of a few strategics judging by the buzz from the floor.
Levita - MARS - To continue the space theme from Moon to MARS - It was great to have a demo of the MARS system. Another bedside assist system for scope and retraction. But retraction with a twist. It is percutaneous retraction using magnets to hold metal grasper tips.
Why????
Well actually there are a few whys…. First you eliminate a port or two - and that for pain and recovery is a good thing. It eliminates a retractor holding and scope holding FTE - so much like moon it is focused on keeping the surgeon bedside - in the lap modality - but using a set of robot arms to replace an FTE. There’s a clear theme coming here in. Lap 2:0.
It’s a first stab by them - and it works. Neat set of disposables - and some cosmetic work needed (in my opinion) on the system to be had. But it works for sure.
Other interesting robots
I will briefly dip off the hardcore surgery robots for soft tissue (which is the focus of this post) and talk a few others in brief. But be assured I’ll cover all the others in details one at a time across my blog in the coming months. But here’s a few highlights:
Histosonics: Talk of the show. Uses a robotic arm to move an ultrasound emitter in a pre planned path to zap deep tumours with zero incisions. Yes Dr McCoy - it is nearly Startrek time.
I was given a great demo on a chunk of bovine liver encapsulated in a hydrogel.
With diagnostic ultrasound a 3D plan using 12 marker points was set (quick and easy).
Then bang - the magic happens. Using focused ultrasound from twin sources the beams converge into a microscopic interference point where energy is hyper focalised. (The marketing team are probably screaming at my shitty description).
A side effect that most Ultrasound companies want to curtail is amplified here and energy literally expands and contracts cells and cell content at the sub cellular level - through expansion and contraction that causes (I think I got it right) a cavitation effect that blitzes the cell content. Now when I say destroys - I don’t mean disrupts and breaks it down - I mean liquifies at the sub cellular level (Liquefaction). So any cancer cells are simply destroyed - denatured and deactivated by liquefaction. This fluid can then be either needle aspirated or actually body absorbed into the lymph.
The margins can be set to determine depth of healthy cell infiltration and it is clean - I mean impressive to see the void that is left. And it should also leave blood vessels intact in say liver tissue.
Go check them out at www.histosonics.com
MMI - Symani: From non invasive to micro robotics. This is using the motion scaling and tremor filtration ability of robots to control sub 3mm wristed instruments in open surgery to perform micro anastomosis of blood vessels or nerves or lymph ducts.
Small calibre - where the anastamosis is critical for outcomes. Symani delivers that patient side with incredibly small wristed instruments.
It again used a 3D screen (I like that) but the in air floating hand controller pencil things. Maybe it’s just because I’m a console guy - but that system with an intuitive style controller would rock. For me you would get way better stability and control - yaw and pitch control from a da Vinci style controller. The roll action on these and the level of control was just too frustrating for me. The system is great and I’m sure you can eventually get it (maybe I was just bad) but rested arms and haptic controllers for me would make that not just good - but incredible.
New segment and Sony showed their tech demo - similar but smaller - different.
Space to watch.
Endobronchial robots
Ion by Intuitive and and Monarch by JNJ were on show. Plus the Medbot (Microport) Trans-bronchial system. Guided catheters that arrive at the terminal bronchial structures. Different approaches - same disease.
It’s a slow uptake of the segment in real terms but it’s getting there. I think every Chinese manufacturer will eventually have one.
Endovascular robots
For me - one of the next big frontiers - and there were a host of cardiovascular robots for structural heart, coronary systems and neurovascular systems.
If telesurgery - teleoperation has one giant place to be it is in this segment - and specifically distance stroke treatment.
6000 labs can do catheters in the USA - only 800 of those can do stroke thrombectomy !!! That screams for remote operation as time is brain. Get rural patient treated at distance and save a % of GDP in stroke recovery costs - no brainer (sorry I didn’t it again…..)
Watch out for my full post coming soon on this exciting segment and the upcoming robots. Quite a few were at SRS.
Telesurgery
Lots of excitement and energy on this. And technologically it is real - with multiple robots demoing their results of telesurgery. Kangduo, Toumai, Mantra 3, Medicaroid.
It’s real - it’s here and the SRS groups are working out how you build infrastructure and regulations to make it happen. Ultimately we need to decide what the “real world” application of this will be - and that rate it is taken up. But there was a huge excitement and enthusiasm for this.
AI / ML
Again - a ton of companies in vision technology, AI / ML and other aspects. Nvidia showed up and most companies are in one way or another partnering with Nvidia.
Lots of companies working out the data of surgery (pre - peri - post) and then what to do with it to structure it - pull out insights and then make it useful.
All the big robotics company have heavily invested into ecosystems that use AI and ML to give insights from their data. Touch Surgery, Asensus ISI, Proximie, My Intuitive, My Versius, Polyphonic (the list goes on)
The secret is will they get actionable insights out?
Can anyone monetise it?
Is it just table stakes for the big robotic companies?
Can companies in Medtech keep up with the pace at which “Apps” evolve. Can they break the molasses of their regularity, quality teams and get spin cycles that app architecture requires?
Will it all be off system (speed) or on system (integration)
Will it be local or cloud?
Will it bring real clinical value?
All to be found out - and I have done a deep dive article on this in my blog for how it is being used in Robotics today.
FDA
Final note - It was amazing to have Binita Ashar and Mark Trumbore from FDA do a session. It was actually one of my favourite sessions - and it signals a great cooperation between industry - clinicians and regulatory.
They acknowledge this is going fast - and said they already have cleared 700-900 AI (or ML) systems in either devices or stand alone.
But they know it is going fast along side robotics.
Exciting to hear how they are becoming the right regulatory parters for new and exciting robotic technology and there up recent clearances for Symani, MIRA and a few more including expansion in prostate etc. This is in stark contrast to Europe and the MDR which has all but killed regulatory willingness in Europe.
They discussed using real world data for regulatory - and data sets for AI / ML training.
The said clearly - “If what you stick in your software improves cyber security - or addresses vulnerabilities - don’t ask - just do.”
But to end on the big one for me. They discussed clustering robotics assisted surgery systems into classes. If you look or smell or feel like a cleared device - and you can demonstrate the same safety profile - and show substantial equivalence - you could - could - maybe get a 510K pathway not a De Novo.
For me that basically just opened the door for clones to get a relative fast track to the USA. That its a little unfair to systems wanting to be hyper innovative and differentiated. But them’s the breaks.
Summary:
Brilliant meeting and if you are a robotic company in any way - healthcare robotic enthusiast - you need to be there. Now let is see how many companies will still be around next year (or have been bought up or wound up) - and let’s see if the big “great robotics round up” to the strategics continues on from Storz. And maybe even Medtronic and JNJ will be there with their robots next year.
More in depth reviews of the technology ether will come.
These are simply opinions and observations of the author and for educational purposes only. You defiantly should not be making business or financial decisions on any of this info.
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